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By B. Akascha. Northwestern College, Saint Paul, MN.

When used in vitro cheap 20mg forzest with visa erectile dysfunction testosterone, fennel is antimicrobial buy generic forzest 20 mg line erectile dysfunction kidney failure, gastric motility- 25 enhancing cheap forzest 20 mg with amex hypogonadism erectile dysfunction and type 2 diabetes mellitus, antiexudative buy forzest 20 mg without prescription erectile dysfunction 27, and presumably antiproliferative. Should not be used for more than 2 weeks without 45 consulting an experienced practitioner. Deutsche Apotheker Ztg 135 (1995), 1425–1440; 8 Massoud H: Study on the essential oil in seeds of some fennel cultivars un- 9 der Egyptian environmental conditions. Some are used to make 21 fabrics, whereas others are used to produce flaxseed oil, a valuable foodstuff 22 and medicinal product. The herb consists of the ripe, dried seeds of 25 Linum usitatissimum and preparations of the same. Some commercial flaxseeds 4 have been identified in the past that contain levels of cadmium beyond recom- 5 mended government limits. It has a very low rate of side effects and does 12 not interfere with the physiology of the bowels. The herb consists of the dried bark 21 of branches and twigs of Rhamnus frangula L. The liquefaction of the bowel 29 contents leads to an increase in intestinal filling pressure. Frangula bark should not be used by children under 10 years of age 34 or by pregnant or nursing mothers. Plant Summaries—F ➤ Herb–drug interactions:Because of the loss of calcium, the drug can increase 1 the effects of cardiac glycosides if taken concurrently. In North America, cascara sagrada (Rhamnus purshianus) is more com- 5 monly used in this way. Flavonoids (rutin), fumaric acid, and hydroxycinnamic acid 21 derivatives (caffeoylmalic acid) are also present. Z Allg Med 34 (1985), 1819; Hahn R, 48 Nahrstedt A: High Content of Hydroxycinnamic Acids Esterified with (+)-D- 49 Malic-Acid in the Upper Parts of Fumaria officinalis. Planta Med 59 (1993), 50 Plant Summaries—F 1 189; Roth L, Daunderer M, Kormann K: Giftpflanzen, Pflanzengifte. Clinical 11 studies demonstrated that the herb inhibits platelet aggregation, increases 12 the bleeding and coagulation times, lowers serum lipids in some individu- 13 als, and enhances fibrinolytic activity. Garlic must be crushed to 26 release allicin immediately before it is used in any way. The herb consists of the peeled fresh 3 or dried rhizomes of Zingiber officinalis R. Gingerols, diarylheptanoids (gingerenones A and B), and starch 7 (50%) are also present. It also 10 has known antibacterial, antifungal, molluscacidal, nematocidal, and anti- 11 platelet effects. The majority of clinical trials per- 36 formed showed a benefit for postoperative nausea, motion sickness, and 37 morning sickness, but a few studies showed no effect. In addition, it increases cere- 7 bral tolerance to hypoxia, reduces the age-related reduction of muscarin- 8 ergic choline receptors and α2-adrenoceptors, and increases the hip- 9 pocampal absorption of choline. In animals, bilobalide and ginkgolides 10 were found to improve the flow capacity of the blood by lowering viscosity, 11 inactivating toxic oxygen radicals and improving the circulation in cerebral 12 and peripheral arteries. Clinical, controlled double-blind 15 studies in humans have confirmed the results of animal experiments (gink- 16 go was found to improve the memory capacity and microcirculation and 17 reduce the viscosity of plasma). Several reports have indicated 29 modest benefit in controlled studies for Alzheimer’s and non-Alzheimer’s 30 dementia. Used for 6 to 8 weeks for treatment of vertigo and tinnitus; longer use 40 is only justified if some improvement can be registered. According to some 41 studies use for at least 3 months is necessary for full effect. Also improvement of walking performance in intermittent claudica- 2 tion has been shown. Despite some positive trials, memory enhancement in 3 healthy persons remains controversial. Treatment should not be initiated be- 4 fore consulting a qualified health care provider. Internationale und statis- 11 tische Klassifikation der Krankheiten und verwandter Gesundheitspro- 12 bleme. Urban & Schwarzenberg, München Wien Balti- 13 more 1994; Dingermann T: Phytopharmaka im Alter: Crataegus, Ginkgo, 14 Hypericum und Kava-Kava. Metaanalyse von 11 klinischen Studien bei Patienten mit 17 Hirnleistungsstörungen im Alter. Arzneim Forsch/Drug Res 44 (1994), 18 1005–1013; Joyeux M et al: Comparative antilipoperoxidant, antinecrotic 19 and scavenging properties of terpenes and biflavones from Ginkgo and 20 some flavonoids. Planta Med 61 (1995), 126–129; Kanowski S et al: Proof 21 of efficacy of the ginkgo biloba special extract Egb 761 in outpatients suf- 22 fering from primary degenerative dementia of the Alzheimer type and multi- 23 infarct dementia. Pharmacopsychiatry 4 (1995), 149–158; Pfister-Hotz G: 24 Phytotherapie in der Geriatrie. The use of its leaves and flowers 3 as a remedy for heart disorders dates back to the nineteenth century. These substances effect an increase in cor- 12 onary blood flow and dilate the blood vessels, thereby enhancing myocar- 13 dial circulation and perfusion. The herb has positive inotropic, chronotropic 14 and dromotropic effects, and improves the tolerance to hypoxia. In animal ex- 15 periments, eczema was found to improve after long-term oral administra- 16 tion of the herb. Soak gauze compresses in the infusion and 21 apply to the affected area of the skin. The herb consists of the whole, dried 39 female inflorescences of Humulus lupulus L. In animals, 2-methyl-3-buten-2-ol was found to 47 produce lasting, profound anesthetic sleep. The bitter acids in hops have 48 antibacterial/antimycotic action and stimulate the secretion of gastric 49 juices. Hence, hops should preferably be taken in 16 combination with other soporific preparations. It relaxes the sphincter of Oddi, demonstrating an antispasmodic ef- 35 fect, which might help explain its traditional use for easing coughs. The es- 36 sential oil constituents, diterpene bitters, tannins, and flavonoids (bitter 37 principles) enhance the secretion of gastric juices. Oral appli- 26 cation was found to significantly improve the symptoms of chronic venous 27 insufficiency in double-blind studies. It was found to significantly reduce 28 leg edemas, similarly to the results of compression treatments. Individuals with chronic venous insufficiency 45 should not abstain from compression treatments. Its wound-healing properties are probably attributable 10 to its content of flavonoids and silicic acid. J Nat Prod 58 (1995), 1024–1031; Wunderer H: Zentral und 40 peripher wirksame Antitussiva: eine kritische Übersicht. The inhabitants of the 46 47 region have used its leaves as a remedy for bladder and kidney disorders for 48 decades. The herb consists of the foliage 1 leaves and stem tips of Orthosiphon aristatus or Orthosiphon spicatus (T. In animal and human studies, the herb was found to have 10 an aquaretic effect (due to the combined effects of saponins and flavo- 11 noids). Its berrylike fruit (cones) have been used for aquaresis 36 and wound healing since ancient times.

Liebenson (2001) explains the need for precision in Cervical involvement with balance assessment when faced with patients with balance problems and gait disturbances: ‘Differentiating between Lewit (1999a) has shown the importance of Hautant’s primary feet buy 20mg forzest erectile dysfunction drugs market, lumbar and cervical disorders is test (Box 6 buy forzest 20mg low cost condom causes erectile dysfunction. It is possible for a skilled practitioner to use this type of refinement to calculate the degree of abnormal Figure 6 generic forzest 20 mg otc erectile dysfunction age 75. If the test results in an abnormal degree of rotation then it should be repeated periodically during and after the use of therapeutic tactics directed at normal- Notes on other balance influences izing dysfunctional patterns revealed during normal Gagey & Gentaz (1996) note: assessment purchase 20mg forzest amex erectile dysfunction drugs market, possibly involving the feet, spine, pelvis, neck or the eyes. When a normal subject keeps his or her head turned to In addition, Gagey & Gentaz suggest other possible the right, the tone of the extensor muscles of the right causes of, and treatment options for, disturbed balance, leg increases, and vice versa for the left side. The using ‘the law of semicircular canals’ difference between these two angles of rotation • plantar input, where mechanoreceptors in the [i. Such deviations may be the result of trigger hand contacts to rest on the appropriate suture, as points or shortened fibers within the musculature the same rocking motion is introduced via the action (deviation will usually be towards the side of of the right hand contacts on the maxillae. Are there any • A hard end-feel to opening, especially when the areas where this is diminished? And, if so, what might range is significantly reduced, may indicate anterior the significance of this be? Cranial assessment, including temporomandibular joint Coronal suture palpation, and observation and palpa- than another. What a surprise it was for us to discover tion of the temporomandibular joint, are outlined in that the axes of motion reproduce exactly those of Boxes 6. The discovery of this phenomenon was purely empirical, and tends to Notes on visceral palpation confirm the idea that ‘cells do not forget’. Accurate visceral palpation requires a high degree of palpatory literacy that can only be accomplished by Additionally, visceral motion is influenced by: practice. There is an inherent axis of rotation in each of these Stone (1999) has described the movement of motions (mobility and motility). In healthy organs, the organs: axes of mobility and motility are generally the same. With disease, they are often at variance with one Visceral biomechanics relate to the movements that the another, as certain restrictions affect one motion more organs make against each other, and against the walls Chapter 6 • Assessment/Palpation Section: Skills 183 Box 6. In some cases the hand can adapt wide postural changes take place that have been char- itself to the form of the organ. Let the hand ances that occur as antagonists become inhibited due passively follow what it feels – a slow movement of feeble amplitude which will show itself, stop to the overactivity of specific postural muscles. The effect on spinal and pelvic mechanics of these imbalances would be to create an environment in This is visceral motility. Empty the release and stretch whatever is over-short and tight, mind and let the hand listen. One visceral palpation exercise for motility – of the In his classic text on body mechanics, Goldthwait liver – is described in Chapter 7 under the subheading (1945) described the changes that are commonly found ‘Visceral manipulation’ (see page 273). The viscera heart, displacing this organ and resulting in ‘articulate’ by utilizing sliding surfaces formed by the traction on the aorta. General assessments: posture and • The pancreas is mechanically affected, respiration interfering with its circulation. Weak muscles: (1) serratus anterior; (2) lower and middle trapezius; (3) deep neck flexors. Shortened muscles: (1A) pectoralis major; (2A) upper trapezius and levator scapulae; (3A) suboccipitals; (3B) sternocleidomastoid. Reproduced with permission from Chaitow (2003b) Chapter 6 • Assessment/Palpation Section: Skills 185 • The prostate becomes affected due to functional tests such as scapulohumeral circulatory dysfunction and increased pressure, rhythm test, core stability (Liebenson 2005, making hypertrophy more likely. Norris 1995) • Similarly, menstrual irregularities become more • Gait analysis is described in Chapter 9. The scope of this chapter does not allow a detailed • Spinal and rib restrictions become chronic, summary of these topics, and the following texts are making this problem worse. Churchill Livingstone, Edinburgh Kuchera (1997) discusses gravitational influences on • Lewit K 1999 Manipulation in rehabilitation of posture: the motor system, 3rd edn. Butterworth- Gravitational force is constant and a greatly Heinemann, London underestimated systemic stressor. Of the many • Liebenson C 2005 Rehabilitation of the spine, signature manifestations of gravitational strain 2nd edn. Mosby, St Louis Kuchera & Kuchera (1997) add a perspective that makes clear how varied are other contextual influ- ences on ‘postural decay’: Breathing pattern evaluation Posture is distribution of body mass in relation to Garland (1994) has summarized the structural modi- gravity over a base of support. The efficiency with fications that are likely to inhibit successful breathing which weight is distributed over the base of support retraining, as well as psychological intervention, until depends on the levels of energy needed to maintain they are, at least in part, normalized. The basic require- reduction in mobility of 2nd cervical segment and ments include: disturbance of vagal outflow. These changes, he states: • Observation – checking key points and aspects of alignment and balance, with patient static. This is both inefficient as a means of breathing and the cause of stress and overuse to the cervical struc- Orthopedic testing and assessment tures. It is clearly evident when severe but may require a deep inhalation to show itself if only slight (Chaitow A selection of standard tests/assessment methods are et al 2002). The descriptions provided are In many ways the breathing pattern assessment not intended to offer a fully comprehensive series of described in Box 6. Scalene evaluation • You stand behind and place your hands, fingers • Rest your hands over the upper shoulder area, finger facing forwards, resting on the lower ribs, thumbs pads resting on the superior aspect of the clavicles. These muscles should be assessed for shortness and The hands should move apart but they will rise if other dysfunctional features. Observe the upper trapezius muscles as they curve These muscles should be assessed for shortness and towards the neck: other dysfunctional features: • Are they convex (bowing outwards)? Pryor & Prasad (2002) report: ‘Paradoxical breathing is • Palpate these muscles and test them for shortness. If so, this leads to retention of excessive levels of tidal air, preventing a full inhalation. This should take not less than 10 seconds restricted in their ability to flex will probably rise in good function. Breathing function evaluation • If the abdomen rose, was this the first part of the The following features should be observed when respiratory mechanism to move or did it breathing function is being evaluated, whether in the inappropriately follow an initial movement of the upper presence of pathology or a habitual breathing pattern or lower chest? Jaw, facial and general postural tension, tremor, tics, See also ‘Breathing rehabilitation methods’ in Chapter 9. In order to be cautious regarding cervical manipulation Valsalva maneuver it is necessary to evaluate the effects of various cervical positions with the patient seated or supine: (1) In order to assess for a space-occupying lesion in the extension; (2) rotation left and right; (3) rotation/ spinal canal the patient is requested to breathe in fully; extension left and right; and (4) position assessed as to hold the nose with one hand, compressing both being required for manipulation. The pressure created will increase • Each position is achieved actively by the patient pressure on neural structures caused by a herniated and should be maintained (possibly with slight disc, a tumor and/or other space-occupying structures, overpressure) by the practitioner for not less than increasing pain and associated symptoms. Note: There are variations in the way this test is performed, • A return to neutral is then actively produced by the as well as cautions that the maneuver itself may aggravate patient and maintained for 10 seconds, before the or cause cardiovascular, venous, neurological or cord- next position is adopted. This test should not be employed if If any of these positions produces symptoms of vertigo, the patient suffers from glaucoma or severe hypertension. Petty & Moore (2001b) suggest that in order to Symptomatic relief (such as a decrease in pain or differentiate dizziness resulting from a compromised paresthesia) is considered positive as it indicates vertebral artery from dizziness caused by the vestibular easing of pressure on nerve roots. This version of the apparatus, the following test should also be conducted: assessment is also known as Spurling’s test. If when the distraction test is applied as Various standard tests described above there are no increased symptoms, it • Phalen’s test (wrist flexion test): Have the patient flex is repeated with the head flexed on the neck. Nerve root compression tests • Froment’s test: With the patient pressing the tip of the • Foraminal compression: the patient is seated or thumb to the tip of the little finger on the same hand, supine and side-flexed to one side or the other (say to have him ‘resist’ as you attempt to separate the two the right in this example). Inability to resist separation is positive for loss the vertex of the skull directed towards the of motor function of the ulnar nerve. If nerve root compression • Patrick’s test: Another name for this test is the is present, pain will radiate into the right arm (i. Pressure is applied to the With the patient supine, place the ankle of one limb vertex of the skull towards the side being turned over the opposite knee (note that the opposite limb towards. Radiating pain noted in the arm indicates remains stationary throughout this procedure).

The Balint technique (Balint buy cheap forzest 20 mg on-line impotence of proofreading poem, 1964) is based on psychoanalysis but has been adapted for general practitioners buy cheap forzest 20mg online men's health erectile dysfunction pills. There is increasing use of psychotherapy by computer (or books - bibliotherapy) rather than by live therapist effective forzest 20mg erectile dysfunction protocol formula. Christensen ea (2004) recruited people with depressive symptoms by survey and assigned them to a cognitive behavioural therapy website or an information website or to an attention placebo condition: only both of the former approaches reduced symptom levels; the authors point out that sustainability of results require testing and that drop out rates can be a problem (do completers differ from non- completers? Nevertheless discount forzest 20 mg line erectile dysfunction treatment karachi, computer-assisted cognitive therapy reduces the need for therapist contact,(Wright ea, 2005) although some contact with a live therapist seems to be important. Computer-assisted cognitive remediation exercises show promise in the amelioration of the cognitive effects of depression (Elgamal ea, 2007) although the benefits in schizophrenia may be less certain. Computer-generated video simulation offers a practical approach to real world fears , e. Specific advice or assistance may be offered and self-help materials may be recommended. Indeed, primary care-based counselling was as effective as cognitive therapy for depression. It aims at limited but definite changes in the way one deals with distressing situations. It is short in duration and is based on the assumption that out of the flexibility that is created by chaos may come improved functioning if guidance is given at the right time. An increased self-awareness is seen as being of greater importance than any delving into the unconscious mind. Joseph 3299 Henry Pratt found that if patients confessed to others in a group and received inspiration from the other group members that their health improved. The group becomes the external world in microcosm, albeit a world in which evoked thoughts and feelings can be safely explored. The average group has about eight members, meets weekly for sessions lasting about an hour, and continues for one to two years. Group therapy has expanded into the wider areas of self-help groups such as weight-watchers, groups for relatives of patients with psychoses, and skill-learning groups. The group leader promotes closeness, interaction, cohesion, a sense of belonging, and mutual concern. The patient/protagonist selects other group members/auxiliaries to adopt roles (parent, sibling, etc) to allow him to relive relevant past/current conflict-laden situations. There is emotion release and learning 3303 Supportive psychotherapy, an often-undervalued intervention (Ursano & Silberman, 2003, p. Supportive therapy is not as glamorous as the so-called ‘brief therapies’ (in fact, most therapies are brief because of dropouts and clinical improvement – Levenson ea, 2000), offspring of psychoanalysis. Techniques include suggestion, reassurance, reinforcement, advice, reality testing, cognitive restructuring, clarification, limit setting, environmental interventions, and current use of medications. It tries to develop an ‘adaptive fit’ between person, who if well informed should decide their needs, and environment. Transference is perhaps the same as (or similar to) the behaviourist’s notion of generalisation. Selected prominent figures from history of psychoanalysis Sigmund Schlomo Freud (1856-1939), founder of psychoanalysis, neurologist, born in Freiburg (now Pribor) in Moravia, parents Jacob Freud and Amalia Natanson. His half-brother Philip made Amalia pregnant, which possibly influenced Oedipus complex3306 idea. A refugee of the Third Reich himself, four of Freud’s five sisters died in Nazi camps. Early on, Freud published neurological and neuroanatomical works, including a monograph on aphasia that Erwin Stengel (1902-1973) translated into English in 1953. Married Martha Bernays, studied under Charcot and published, with Josef Breuer (1842-1925: of reflex fame) Studies on Hysteria in 1895. Possibly addicted to cocaine; his colleague, Carl Koller (1857-1944), discovered its local anaesthetic properties. During this period, immortalised in Traumdeutung (1990), Freud corresponded with Wilhelm Fliess, inventor of the concept of a nasal reflex neurosis. Freud analysed himself, so starting a family of analysts, and each member thereafter being analysed by someone who was analysed by someone else. Claims for cures criticised in recent years, with talk of former patients dying in mental hospitals. He provided a framework allowing the conceptualisation of mental processes where there had previously been only demonology and degeneracy. Freud may have got major ideas from the German philosopher Friedrich Nietzsche (1844-1900). Merskey attacked Freud’s idea of ‘repression’, believing that it has been used unethically to produce false memories of sexual abuse in infancy. Suffered from carcinoma of maxilla and palate from 1923 and received repeated surgery and radiotherapy. On September 23, 1939 in London, his physician and friend Max Schur administered an overdose of morphine at Freud’s request. Bertha or Elsa Pappenheim (Anna O)(1859-1936) is the best known patient of Freud and Breuer. Lessons learned during her treatment were used in the writing of Studies on Hysteria. Merskey argues she had a depressive disorder, morphine and chloral hydrate dependence, hysterical conversion, and cyclothymia! Other patients of Freud included Ida Bauer (Dora) and Sergej Pankejeff (Wolf Man). She observed children at play, was analysed by her father, had no medical qualification, and remained a spinster. Carl Gustav Jung, (1875-1961) leader of the school of ‘analytical psychology’, student of Janet, and a pastor’s son, was born in Switzerland and worked with Bleuler at Zurich. Jung was concerned with the inner world of fantasy and with interpreting unconscious material in dreams and artistic production. A ‘complex’ consists of a group of interconnected ideas that arouse feeling and influence action. In reality, many people do not remember much about this phase in their life because it did not cause much upset at the time. Melanie Klein (1882-1960) worked with pre-oedipal children using play analysis and she placed the Oedipus complex in infancy! Objects, for the infant, are good or bad; part is confused with whole: breast is equated with mother. At about six months the baby is biting objects (oral sadistic stage) and fears mother will punish him for this hostility. Klein’s ‘projective identification’ (subject projects part of self onto object, then identifies with object or elicits response in object corresponding to qualities of the projection) was further developed by Wilfred Bion (1897-1979). Klein’s first ‘patient’ was her own daughter, Melitta Schmideberg, who later became an analyst working with delinquent adolescents and who resented her own mother’s intrusions so early in life! Alfred Adler (1870-1937) was born in Vienna, had rickets as a child, trained as an eye specialist, converted to Christianity from Judaism, and died at Aberdeen. He later broke with Freud, rejected libido theory, founded ‘individual psychology’, and taught that contemporary environmental factors were more important than sex in determining human behaviour. Harry Stack Sullivan, (1892-1949) stressed interpersonal dynamics and defined personality in terms of relative and enduring patterns of recurring interpersonal behaviour. Sullivan discussed everyday events with his clients and used pointed questions and provocative statements in preference to theory-based interpretations.

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